Case Study: Assessing Heart and Neck Vessels

Case Study: Assessing Heart and Neck Vessels

Case Study: Assessing Heart and Neck Vessels 150 150 Peter

Case Study: Assessing Heart and Neck Vessels

A 50-year-old Black female client is admitted to the health care facility with mitral valve prolapse. The client states that a week ago, she became dizzy and began to perspire while at work. She was working at the computer in her office on a major project that was due that day. The client attributed the episode to the stress and anxiety she was experiencing from finishing the project, so she put a cold wet towel around her neck and continued working. The next day, she woke up with a headache and felt a little tightness in her chest. She took an aspirin, and the symptoms subsided. The client became alarmed today when the tightness in her chest felt more like a pain. The client’s presenting symptoms include fatigue, headaches, and sharp chest pains.

Vital signs: BP 160/90 mm Hg, HR 110 beats/min, RR 24 breaths/min, temp. 98.0° F (36.7°C), pulse ox 96%, skin is warm; the nurse notes the client is perspiring. Her weight is 30 lb over what it should be. She gives a history of having a murmur since she was little but that it never caused her any problems. She takes cholesterol and blood pressure–lowering medications daily.


a. What are conditions that contribute to turbulent blood flow or heart murmurs?

b. What are three techniques used to assess the precordium and heart sounds?

c. Based on these symptoms and history, what is the correct landmark for auscultation of heart sounds in this client?

d. What kind of heart sounds may be heard in this client?

e. When teaching this client about coronary heart disease (CHD), which risk factors are important for the nurse to emphasize?

f. If the client asks the nurse if the murmur she has is causing the symptoms, how should the nurse respond?

g. Write a proper nursing diagnosis for this client with 2 nursing interventions with rationales.

Sample Answers

Case Study: Assessing Heart and Neck Vessels

a. Exercise, pregnancy, and anemia can all cause a high blood flow, as can hyperthyroidism, fever, and rapid growth spurts. This could lead to an innocent murmur. Valve disease-related murmurs: Problems with a valve in the heart, such as aortic stenosis or a bicuspid aortic valve, can lead to a heart murmur.

b. Major areas on the precordium: Aortic, pulmonic, tricuspid, and mitral (Apical). Inspection, Palpitation, and auscultation are three techniques used to asses the precordium and Vasculature. Inspect the entire precordium for movement.

c. Place the diaphragm of the stethoscope at the 5th intercostal space, mid-clavicular line (same area as the apex beat). This is the anatomical landmark for the mitral valve. Listen for at least 5 sec for the first heart sound, which represents the mitral valve closing.

d. If you have mitral valve prolapse, your doctor may hear a clicking sound, which is common with this condition. Your doctor may also detect a heart murmur, which would be due to blood leaking back into the left atrium.

e. The traditional risk factors for coronary artery disease are high LDL cholesterol, low HDL cholesterol, high blood pressure, family history, diabetes, smoking, being post-menopausal for women and being older than 45 for men. Obesity may also be a risk factor.

f. This may not cause problems if only a small amount of blood leaks back into the left atrium.

More severe mitral valve regurgitation can cause symptoms such as shortness of breath, fatigue or lightheadedness. Another name for mitral valve prolapse is click-murmur syndrome.